EFFICACY OF ISOLATION OF ANTI-HCV POSITIVE PATIENTS IN THE HEMODIALYSIS SETTING

Background. We studied the role of blood transfusions and dialysis mac hines on hepatitis C virus transmission in hemodialysis patients, and the impact of isolation anti-HCV positive patients on hepatitis C inci dence. Methods. We prospectively studied 50 hemodialyzed patients, ant i-HCV negative and with normal ALT levels at the beginning throughout a 18 month followup period. HD machines, HD duration, rate of blood tr ansfusions, ALT, AST, HBsAg, Anti-HBs, Anti-HBcAg, HBsAg, HBcAb and se rologic markers of HAV, CMV, HSV, EBV and HCV (ELISA 2 and INNO-LIA) w ere evaluated. During 1993 we isolated the anti-HVC positive patients in a separate area with different HD machines and staff members. Bimon thly screening for liver enzymes and serologic markers of HCV was perf ormed in 45 anti-VHC negative patients. Results. Eleven patients (22 % ) became anti-HCV positive. Anti-HCV positive patients had a significa tly longer length of time on HD (86 +/- 33 versus 45 +/- 37 months, p = 0.003) and also more transfusions (13.4 +/- 11 versus 5.7 +/- 9, p = 0.05), than anti-HCV negative patients. Two HD machines were a risk f actor for HCV seroconversion: machine 1 (Relative risk [RR] = 6.8 (95 % confiance in tervales = 1.2-37, p = 0.01) and machine 7 (RR = 6.9, C I = 1-48, p = 0.03). This last one was a strong risk factor (RR: 32, C I: 3.2-316, p = 0.0001) for five anti-HCV positive patients that had n ot been transfused at all from, at least, two years prior to ALT eleva tion. In 1993, three patients (6.6 %) became seroconverters during the first 5 months. In 1993 the current incidence for HCV seroconversion has significantly fallen (5 %) (In 1991 and 1992 is was 14.2 % and 13. 9 %, respectively) (p = 0.006). Conclusions. This report shows that ti me on HD, blood transfusions and dialysis machines were risk factors f or HCV transmission in hemodialysis patients and suggest that isolatio n of HCV positive patients may be useful to reduce the incidence of HC V infection.